Summary: Mr X complained the Care Provider increased the fee for his relative Ms Y’s care. The Care Provider should have kept a signed copy of the terms and conditions document for Ms Y’s care. This did not cause injustice, because Mr X was aware through signing a different document at the start of Ms Y’s residence, that her fees may increase. And the Care Provider wrote to him before the increase to make him aware of it.

The complaint

1. Mr X complained about the increase to his relative Ms Y’s care home fees this year. He said the increase affects the long-term sustainability of her placement and means she may have to move.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
3. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)
4. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

5. I considered evidence provided by Mr X and the Care Provider as well as relevant law, policy and guidance.
6. Mr X and the Care Provider had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

Relevant law and guidance

7. Where a service user will be responsible for paying the costs of their care or treatment (either in full or partially), the care provider must provide a statement to the service user, or to a person acting on the service user's behalf—
• specifying the terms and conditions in respect of the services to be provided to the service user, including as to the amount and method of payment of fees; and
• Including, where applicable, the form of contract for the provision of services by the service provider.

(The Care Quality Commission (Registration) Regulations 2009, Regulation 19)

8. The intention of this regulation is to make sure that providers give timely and accurate information about the cost of their care and treatment to people who use services.
9. Care Quality Commission’s guidance on Regulation 19 says providers must notify people of any increase in fees to give them enough time to consider whether they wish to continue with the service. People should have reasonable notice of changes.

What happened

10. Mr X signed an admission agreement in 2022 setting out Ms Y’s fee. The agreement said he would be given not less than four weeks’ notice of any change in the amount.
11. As well as the admission agreement, the Care Provider sent us an unsigned document called ‘Terms and Conditions of Residence: Self-funded Residents’. The copy is not signed.
• Clause 1.5 says fees are normally reviewed twice a year and people will be given at least two months’ notice of any change; fee increases will apply at the end of the notice period’
• Clause 1.6 says in addition to the reviews in Clause 1.5, fees will be reviewed where extra care is provided or there is a change to the level of care required by the resident and to ensure compliance with statutory requirements coming into force after the last review of fees. The Care Provider will use reasonable endeavours to give not less than two months’ notice, but it reserves the right to give shorter notice in appropriate circumstances.
12. The Care Provider completed dependency assessments for Ms Y each month. These assessments give a score based on answers to a series of questions about a person’s level of care need. Between January and October 2024, Ms Y was ‘level two/medium dependency.’
13. At the end of November 2024, the Care Provider sent Mr X a letter saying it would be increasing Ms Y’s fee. It explained this was due to increases in national wage, taxation, insurance, finance, health and safety and regulatory environmental costs. It said costs were higher than inflation.
14. Mr X emailed the Care Provider at the start of January 2025 saying he had checked his bank account and noticed a large increase. He asked a member of staff to contact him to discuss the fee.
15. The Care Provider treated Mr X’s contact as a complaint and responded within two weeks saying it had written to him in November 2024; he did not receive the letter until January 2025, and it could not say why as all the letters went out at the same time. The Care Provider went on to say it had been affected by the latest budget; Ms Y needed two carers for transfers and personal care and close monitoring of her eating and drinking.
16. Mr X complained to us. Meantime, the Care Provider sent a further complaint response to him saying its costs remained high because of increases in insurance, health and safety and inflationary increases across products it used and increases to wages. It went on to say that it considered an individual’s dependency and it could not reduce Ms Y’s fee because of the care she needed.

Findings

17. Mr X did not receive a copy of the November 2024 letter telling him of the increase until January. I do not know the reason for the delay. It could have ben delay by the postal service or by the Care Provider’s administration. It is not proportionate to consider this point further.
18. The Care Provider should have kept a signed copy of the terms and conditions of residence which Mr X should have signed as Ms Y’s representative when she moved into the care home. This is to evidence Mr X had sight of all applicable information about fees. The Care Provider’s failure to ensure it kept a signed copy was not in line with Regulation 19. However, it did not cause any injustice because Mr X signed another agreement which explained he would have at least four weeks’ notice of fee increases. And the Care Provider has explained in full in the fee increase letter and in the complaint responses the reasons for the increase. This also means there is no injustice.
19. The Care Provide increases fees for two main reasons:
1. A resident’s care needs have increased based on an individual dependency score which is reviewed monthly. This did not apply in Ms X’s case for the increase which took effect in January 2025 because her score remained medium in 2024.
2. General costs (legal, regulatory, tax and environmental).
20. Point (b) is the reason for the increase in fee which has been applied to all self-funding residents. There is no fault in the Care Provider increasing the fee, it is entitled to do this, but it needs to give notice. The Care Provider gave four weeks’ notice of the increase and explained why briefly. Tax and other costs have gone up. It isn’t for the LGSCO to say what the fee should be, we consider whether the Care Provider has acted in line with the regulations and guidance on Regulation 19. It has done so in this case.
21. The sustainability of Ms Y’s placement is not a matter the Care Provider has to consider. Once her savings and other assets fall to a certain amount, she will likely be entitled to state funding towards the cost of her care and the relevant state body (NHS or council) will consider whether to maintain or change the placement based on relevant law and guidance.

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Decision

22. I find no injustice.

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Investigator's decision on behalf of the Ombudsman